Prenatal Diagnosis of Right-Sided Congenital Ventricular Diverticulum (CVD) Assisted by Spatiotemporal Image Correlation (STIC) Acquisition and the Speckle-Tracking Technique to Assess Fetal Cardiac Function: A Case Report

Figures

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  Figure 1. This is a figure. Schemes follow the same formatting.(A) At 26+2 weeks GA, the upper fetus showed globular RV enlargement compared with (B) the lower fetus, who had a normal heart. (C) At 30+5 weeks GA, the globular shape of the RV remained unchanged, but (D) holosystolic TR was observed. (E) Doppler evaluation of the ductus venosus showed normal findings. Ant, anterior; Lt, left; LV, left ventricle; Post, posterior; Rt, right; RV, right ventricle.

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  Figure 2. At 35+2 weeks GA, fetal echocardiography was performed. (A) B-mode image of four-chamber view. The globular RV persisted. (B) The cardiac image with STIC technology. The outpouching ventricular wall (arrowhead) was observed and had a thickness and layering similar to those of the rest of the ventricle. (C) Video still image of the 4D video, which was acquired by surface-rendering mode of the STIC volume in grayscale. Ant, anterior; Lt, left; LV, left ventricle; Post, posterior; Rt, right; RV, right ventricle; STIC, spatiotemporal image correlation.

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  Figure 3. Measurement of the GSI.(A) The measurement of the GSI in the fetus with CVD at each gestational age. The first two scans (GA26+5 weeks, GA 30+5 weeks) were performed with B-mode imaging. The latter two scans (GA33+5 weeks, GA35+5 weeks) were performed with STIC imaging with FetalHQ. (B) The measurement of the GSI in the first two scans (GA26+5 weeks, GA 30+5 weeks). In the 4CV, the basal-apical length (BAL) was measured at end-ventricular diastole from the epicardial border of the posterior atrial wall to the epicardial border of the apical ventricular wall. Transverse length (TL) at the widest part in the 4CV from the epicardial borders of the ventricular walls. The GSI was calculated formally with BAL/TL, and it was compared with the z score referenced in DeVore 2017. (C) The measurement of the GSI in the healthy fetus at each gestational age. The first scan (GA26+5 weeks) was performed with B-mode imaging. The latter scan (GA33+5 weeks, GA35+5 weeks) was performed with STIC imaging with FetalHQ. EFW, estimated fetal weight; GA, gestational age; GSI, global sphericity index; wks, weeks.

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  Figure 4. Twenty-four-segment ventricular analysis and the 24-segment sphericity index at a GA 35+2. (A) LV geometry of the fetus with CVD. The upper graph shows the results of the 24-segment ventricular analysis. The lower graph shows the results of the 24-segment sphericity index analysis. (B) RV geometry of the fetus with CVD. The upper graph shows the results of the 24-segment ventricular analysis. The lower graph shows the results of the 24-segment sphericity index analysis. The RV was wider than the reference value and was particularly prominent at the base (1–8) and mid (9–16) regions, the widths of which were out of range. (C) Twenty-four-segment sphericity indices of the healthy fetus. All measurements were above the 10th percentile. LV, left ventricle; Rt, right; RV, right ventricle; SD; standard deviation.

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  Figure 5. FetalHQ results of the fetus with CVD using the speckle-tracking technique at a GA 35+2 wks. CO, cardiac output; EdoGLS, endocardium global strain; EDA, end-diastolic area; EDS, end-systolic area; EF, ejection fraction; ESL, end-systolic length; ESDbas, end-systolic displacement of basal; FAC, fractional area change; GA, gestational age; Lat, lateral; LV, left ventricle; MAPSE, mitral annular plane systolic excursion; RV, right ventricle; Sep, septal; SV, stroke volume; TAPSE, tricuspid annular plane systolic excursion; wks; weeks.